Conferencia de resultados del T3 de 2026 de Tactile Medical (TCMD): El crecimiento en linfedema eleva las previsiones de EBITDA

Conclusiones clave

• Tactile Medical registró unos ingresos en el tercer trimestre de 2026 de 91,9 millones de dólares, lo que supone un aumento interanual del 7,1%, ya que el crecimiento en el negocio de linfedema compensó las menores ventas en despeje de vías respiratorias.
• Los ingresos por linfedema aumentaron un 13,1% hasta los 81,8 millones de dólares, lo que marca un quinto trimestre consecutivo de crecimiento de doble dígito por encima del mercado. Los ingresos procedentes de Medicare aumentaron aproximadamente un 11% y los ingresos comerciales crecieron cerca de un 17%.
• Los ingresos por despeje de vías respiratorias cayeron un 25,1% hasta los 10 millones de dólares, debido a que ciertos clientes de equipos médicos duraderos (DME) continuaron reduciendo el exceso de inventario de AffloVest. La directiva prevé una mejora secuencial en el cuarto trimestre, aunque a un ritmo más lento de lo anticipado anteriormente.
• El margen bruto se amplió 90 puntos básicos hasta el 76,7%, en lo que supone el duodécimo trimestre consecutivo de mejora interanual. El EBITDA ajustado fue de 14,3 millones de dólares, con un margen del 15,6%.
• La empresa mantuvo sus previsiones de ingresos para todo el año entre 360 y 366 millones de dólares y elevó la previsión de EBITDA ajustado a un rango de entre 50 y 52 millones de dólares.
• Tactile Medical cerró el trimestre con 75,1 millones de dólares en efectivo y sin deuda pendiente, tras generar 12 millones de dólares en flujo de caja operativo y recomprar aproximadamente 6,2 millones de dólares en acciones.

Datos financieros clave

Los ingresos en el acumulado del año aumentaron un 12% hasta los 252,8 millones de dólares, impulsados por un crecimiento del 15% en linfedema. El EBITDA ajustado acumulado en el año subió aproximadamente un 35% hasta los 29,5 millones de dólares.

Rendimiento comercial y operativo

El segmento de linfedema se mantuvo como el principal motor de crecimiento. Los ingresos aumentaron un 11% de forma secuencial a medida que se estabilizó la alteración en los pedidos de Medicare asociada a los requisitos de autorización previa de abril de 2026. La directiva señaló que esa alteración temporal ya ha quedado atrás.

La ejecución comercial también respaldó el crecimiento. Las visitas a clínicas aumentaron un 19% interanual en el T3, mientras que las clínicas remitentes crecieron más de un 10% en el acumulado del año. Eventos de marketing seleccionados para médicos generaron un aumento de pedidos de entre el 20% y el 45% entre las cuentas participantes en los 90 días posteriores a cada evento en comparación con los 90 días previos.

Tactile Medical capacitó a más de 13.000 médicos durante 2026, lo que representa ya un 25% más que en todo 2025. La empresa también creó un equipo de cuentas estratégicas enfocado en los sistemas sanitarios de mayor tamaño, redes integradas de prestación de servicios de salud y cuentas de alto volumen.

Las inversiones tecnológicas están destinadas a la conversión de prescripciones en envíos. La empresa indicó que las mejoras tecnológicas redujeron el tiempo medio de revisión de expedientes médicos en aproximadamente un 50%. Steve Kiewiet se incorporó como director de operaciones (COO) para supervisar las operaciones de pedidos y los servicios al paciente bajo una organización unificada.

En cuanto al desarrollo de productos, Tactile Medical obtuvo la ampliación de la autorización FDA 510(k) para el escáner 3D LymphaTech a fin de proporcionar mediciones de circunferencia y volumen que ayudan en la evaluación del linfedema. Su solicitud del código CPT de Categoría III está programada para su revisión final en la reunión de febrero de 2027.

La empresa presentó una solicitud 510(k) para Flexitouch Pro en octubre y prevé un lanzamiento comercial en el segundo semestre de 2027, sujeto a la conclusión del proceso regulatorio. Está previsto que a finales del T4 de 2026 comience una prueba piloto específica en la VA para MyoSleeve; no se incluye ninguna contribución de MyoSleeve en las previsiones para 2026.

Previsiones de la directiva

Tactile Medical mantuvo las previsiones de ingresos para todo el año 2026 de 360 a 366 millones de dólares, lo que representa un crecimiento de aproximadamente el 9% al 11%. La directiva sigue esperando un crecimiento anual de rango bajo del doble dígito en linfedema.

La empresa prevé ahora que los ingresos anuales por despeje de vías respiratorias disminuyan en un porcentaje de entre el rango medio y alto del simple dígito, frente a su expectativa anterior de un comportamiento prácticamente estable. La directiva prevé una mejora secuencial en el T4, aunque los ingresos deberían mantenerse por debajo del mismo periodo del año anterior.

La previsión de EBITDA ajustado para todo el año se elevó a entre 50 y 52 millones de dólares, lo que implica un crecimiento de aproximadamente el 12% al 16% desde los 44,8 millones de dólares de 2025.

Otras hipótesis para todo el año incluyen:

• Margen bruto GAAP de aproximadamente el 76,5%.
• Crecimiento de los gastos operativos GAAP del 10% al 12%.
• Ingresos netos por intereses de aproximadamente 2,4 millones de dólares.
• Tasa efectiva de impuestos de aproximadamente el 28%.
• Promedio ponderado de acciones diluidas en circulación de aproximadamente 23 millones.

La directiva prevé un crecimiento secuencial significativo en linfedema en el T4, aunque el crecimiento interanual debería moderarse en comparación con el T4 de 2025, cuando el negocio creció un 16% tras el beneficio inicial de la alineación con la Determinación de Cobertura Nacional. El rango de ingresos totales también depende del momento en que se produzca la conversión de prescripciones en envíos durante el trimestre estacionalmente más importante.

Riesgos y aspectos a vigilar

• Varios clientes de DME están tardando más de lo previsto en reducir el exceso de inventario de AffloVest. Tactile Medical carece de visibilidad en tiempo real del inventario en las instalaciones de cada cliente y los pedidos están concentrados en un número reducido de clientes.
• La mejora en el despeje de vías respiratorias depende de la normalización del inventario. La directiva afirmó que el problema refleja el momento de realización de los pedidos y no cambios en la demanda de los pacientes, la competencia o la eficacia de la terapia.
• El crecimiento en linfedema se enfrenta a una comparativa exigente en el T4, mientras que la programación de los envíos depende de la completación de la documentación y del procesamiento de los pedidos.
• Se prevé que la ampliación del reembolso para LymphaTech y el linfedema de cabeza y cuello se desarrolle paulatinamente. La directiva advirtió que los nuevos productos y los cambios en las políticas no deberían generar una aceleración inmediata en las prescripciones o los ingresos.
• Las inversiones en la plataforma de gestión de pedidos continuarán hasta 2028, aunque la directiva mantiene su compromiso de generar apalancamiento operativo.

Puntos destacados del turno de preguntas y respuestas de analistas

La directiva afirmó que no ve ninguna razón para que el mercado de linfedema o la posición de Tactile Medical se desaceleren, citando el continuo infradiagnóstico, el aumento de la concienciación en el mercado y la ejecución comercial. Sin embargo, enfatizó que LymphaTech, Flexitouch Pro y los cambios en las políticas de los pagadores requerirán tiempo para traducirse en ingresos.

En cuanto a Flexitouch Pro, la directiva espera que el reembolso se mantenga coherente con el código existente y que el margen bruto esté en consonancia general con la cartera actual de Flexitouch.

Respecto a AffloVest, los clientes sin exceso de inventario han proporcionado excelentes comentarios de médicos y pacientes sobre el sistema de última generación. Sin embargo, su rendimiento no basta para compensar por completo la menor reducción de inventario entre los clientes de DME afectados.

La empresa prevé ajustar la cobertura sobre el terreno dividiendo los territorios de mayor tamaño y consolidando de forma selectiva los de menor rendimiento. La directiva describió la nueva función de cuentas estratégicas como una evolución de su modelo comercial, pero no anticipa ingresos relacionados en el T4 de 2026.

Actualmente, LymphaTech genera ingresos bajo un modelo SaaS en varios centros académicos de gran tamaño. La directiva sigue evaluando el modelo comercial a más largo plazo e indicó que se prevé una comercialización más amplia más adelante, en 2028 y 2029.

Transcripción completa de la llamada de resultados

Transcripción completa de la conferencia de resultados

Comentarios de la dirección

Operator

Welcome, ladies and gentlemen, to the Third Quarter 2026 Earnings Conference Call for Tactile Medical. [Operator Instructions] Please note that this conference call is being recorded and will be available on the company's website for replay shortly.

I would now like to turn the call over to Sam Bentzinger, Investor Relations at Gilmartin Group for a few introductory comments. Please go ahead.

Sam Bentzinger

Good afternoon, and thank you for joining today's call. With me from Tactile Medical's management team are Sheri Dodd, Chief Executive Officer; and Elaine Birkemeyer, Chief Financial Officer.

Before we begin, I'd like to remind everyone that our remarks and responses to your questions today may contain forward-looking statements that are based on the current expectations of management and involve inherent risks and uncertainties. This could cause actual results to differ materially from those indicated, including those identified in the Risk Factors section of our annual report on Form 10-K as well as our most recent 10-Q filing to be filed with the Securities and Exchange Commission.

Such factors may be updated from time to time in our filings with the SEC, which are available on our website. We undertake no obligation to publicly update or revise our forward-looking statements as a result of new information, future events or otherwise. This call will also include references to certain financial measures that are not calculated in accordance with generally accepted accounting principles or GAAP. We generally refer to these as non-GAAP financial measures. Reconciliations of those non-GAAP financial measures to the most comparable measures calculated and presented in accordance with GAAP are available in the earnings press release on the Investor Relations portion of our website.

With that, I'll now turn the call over to Sheri.

Sheri Dodd

Thanks, Sam. Good afternoon, everyone, and welcome to our third quarter 2026 earnings call. Here with me is Elaine Birkemeyer, our Chief Financial Officer. We delivered total revenue of $91.9 million in Q3, led by a 13% year-over-year growth in lymphedema, marking our fifth consecutive quarter of above-market double-digit growth.

This consistency demonstrates the durability of our leadership position and the substantial runway created by a market that remains significantly underpenetrated. Airway clearance revenue was $10 million, down year-over-year as anticipated due to the onetime DME inventory transition associated with the launch of our next-generation AffloVest system. The same DME customers we highlighted in Q2 continued to work through temporary excess inventory during Q3. There were no material changes in the underlying dynamics of the business, and we continue to expect airway clearance revenue to improve sequentially in the fourth quarter.

Across the portfolio, we continue to balance strong growth in our core lymphedema business with disciplined execution. Gross margin expanded 90 basis points year-over-year in Q3 to 76.7%, contributing to adjusted EBITDA of $14.3 million. This marks the 12th consecutive quarter of year-over-year gross margin expansion. Importantly, we have achieved this sustained improvement while continuing to invest in our product offerings to deliver greater value to patients and providers.

Based on our year-to-date performance and our expectations for the fourth quarter, we are maintaining our full year 2026 revenue guidance of $360 million to $366 million and raising our adjusted EBITDA guidance to $50 million to $52 million. This outlook reflects our continued confidence in low double-digit growth in our business and our expectation for sequential improvement in airway clearance revenue in the fourth quarter. We expect full year airway clearance revenue to decline mid- to high single digits year-over-year.

I'll now turn a closer review of our lymphedema business line, including Q3 performance and recent progress against our 3 strategic priorities. Elaine will then review our financial results and the outlook for the remainder of the year. Lymphedema remains our core business and primary growth.

Our Q3 results demonstrate our market leadership in both basic and advanced pneumatic compression devices with revenue growing 13% year-over-year to $81.8 million. Sequentially, lymphedema revenue grew 11%, supported by a recovery from the Medicare ordering timing disruption associated with the April implementation of prior authorization requirements.

As expected, the prior authorization process has stabilized as our teams and the MACs have gained experience with the new requirements, and we believe this timing disruption is now behind us.

Medicare revenue returned to growth in Q3, up 11% year-over-year. Beyond Medicare stabilization, the quarter's performance was driven by execution across several key drivers. Our go-to-market investments in sales reps and CRM technology are extending the reach and impact of our commercial organization. Clinic visits increased 19% year-over-year in the third quarter, and referring clinics grew more than 10% year-to-date. These results are enabled by enhanced market insights that help our teams identify and prioritize referral opportunities across our account base.

Our clinician-focused marketing programs are also delivering measurable returns with select events generating 20% to 45% order growth from participating accounts in the 90 days following the event compared to the 90 days prior. And through our medical education team, we have educated more than 13,000 clinicians who treat lymphedema patients so far in 2026, already 25% more than in all of 2025. This expands the number of providers equipped to identify patients and refer them to appropriate therapy.

Additionally, broader patient access to advanced pumps remains durable following our tighter alignment with the NCD policy, and this is reflected in our product mix. As part of the next phase of our go-to-market playbook, this quarter, we established a dedicated strategic accounts team within our broader commercial organization. This team will focus on deepening engagement with larger health systems and IDNs while expanding referral opportunities within existing high-volume regional and national accounts.

Taken together, these trends give us confidence in our ability to deliver sequential lymphedema growth in Q4. We are beginning to see benefits from investments in our operating model and order process, which are improving efficiency and service quality as patients move from referral to therapy. The strong prior year comparison next quarter resulting from the initial benefit of our alignment with the NCD will moderate year-over-year growth but does not change our confidence in the underlying momentum of the business.

Looking beyond our third quarter results, we are executing well on our 3 strategic priorities designed to sustain double-digit growth, expanding access to care, creating value across the patient journey and expanding treatment options. Together, these priorities form a compelling growth model, supporting performance today while strengthening the drivers for sustained lymphedema performance over time.

As with most market development opportunities, growth starts with diagnosis. Patients must first be identified, diagnosed and referred before we can help them access clinically appropriate therapy.

Expanding access to care means helping more patients get diagnosed and referred into the care pathway, but a referral is only the beginning of the order process and growth also requires pulling a higher percentage of referrals through to shipments. Today, not every diagnosed patient with lymphedema makes it through the documentation and order process necessary to receive therapy. And each patient lost along the way is a diagnosed patient who potentially goes underserved.

Creating value across the patient journey is about closing the gap and converting more eligible referrals to shipments, which is where we serve the patient and how we generate revenue. And expanding treatment options supports every step of that pathway. A broader portfolio gives clinicians more solutions for their patients, supports more additional referral opportunities and extends the patient populations and disease stages we can serve. As these capabilities scale, we also expect greater productivity and operating leverage to support adjusted EBITDA growth over time.

Put simply, sustained growth in our lymphedema business is not solely a function of adding sales representatives. It comes from helping more patients get diagnosed and referred, supporting more of those referrals so they can reach therapy and expanding the range of patients and therapy needs we can address.

Our first priority is expanding access to care through earlier diagnosis and broader patient coverage. The opportunity is significant. An estimated 20 million people in the U.S. are living with undiagnosed lymphedema and many diagnosed patients continue to face coverage barriers. Our LymphaTech 3D Scanner currently gives clinicians an FDA-cleared quantitative way to measure limb volume and circumference, supporting earlier and more consistent identification of the disease.

We are encouraged that LymphaTech is currently in use and generating revenue at leading academic medical centers, even ahead of an established reimbursement pathway, demonstrating its utility in clinical practice. We recently achieved an important regulatory milestone, receiving FDA 510(k) clearance for an expanded indication of the LymphaTech 3D Scanner.

LymphaTech is now cleared to provide circumference and volume measurements to aid in the assessment of lymphedema. This expands LymphaTech's clinical positioning beyond measurement and surveillance alone, and this expanded indication strengthens the foundation for our broader diagnostic strategy, including our work on clinical adoption, reimbursement and further integrated diagnostics.

On LymphaTech 3D Scanner reimbursement, our application for a Category III CPT code was discussed during our Q2 earnings call and is scheduled for final review at the February 2027 meeting. While a Category III code is a tracking code rather than a coverage decision, it is an important step towards broader reimbursement.

Together, these regulatory milestones are intended to support wider adoption of LymphaTech, enabling earlier and more objective identification of lymphedema and monitoring of fluid over time and ultimately helping bring more patients into the care pathway.

We are also making progress in broadening payer access for patients who already have been diagnosed with lymphedema. Following publication of the 6-month results from our randomized controlled trial of Flexitouch therapy for head and neck cancer-related lymphedema, we have begun to see movement among commercial payers with a small number removing restrictive experimental and investigational designation from their policies.

Significant work remains, but these early policy changes demonstrate that our clinical evidence and payer engagement can expand coverage over time, opening access to therapy for more eligible patients and supporting additional referral opportunities.

Our second priority is creating value across the patient journey. While we see opportunities to improve the experience at every stage of care, our current focus is on the highest impact stage of the journey, helping more eligible patients successfully start therapy. By reducing friction in the upfront documentation and order process, we can improve conversion from referral to shipment and ensure more patients receive the therapy prescribed by their clinician.

This benefits patients, simplifies the experience for referring clinicians and their staff and supports a more efficient and stable operating model. Ultimately, increasing access to therapy is a key driver of both patient value and sustainable growth. During the quarter, we made organizational and operating model changes to strengthen how orders move from referral to shipment.

We also continue to replatform our end-to-end order process through our AI-enabled order management platform and care navigation work. Together, these efforts are designed to reduce friction, improve visibility into patient progression and strengthen execution across the referral to shipment process. We are already seeing tangible results in medical record review, one step within the broader order process, where technology-enabled improvements have reduced average review time by approximately 50%.

While meaningful work remains, this early result demonstrates the potential to improve service levels, increase capacity and support future order growth more efficiently as we extend these capabilities across the end-to-end process.

Building on this progress, we are taking another important step in the evolution of our operating model. As announced today, Steve Kiewiet, is joining Tactile Medical as Chief Operating Officer. In this newly created role, Steve will lead our order operations and patient services teams, connecting capabilities that support a patient from referral through shipment into one operating organization.

This structure will enable more coordinated decision-making across the full journey and help us extend process improvements more broadly, creating a better experience, greater capacity and a more scalable operating model. Steve brings breadth and depth of experience in revenue cycle management, field-based patient educators, call center and DME operations. This is the right time to bring an executive level enterprise operations leader to our team, and we are excited to have him on board.

Our third priority is expanding treatment options. A broader innovation portfolio allows us to address more patient needs, support additional referral opportunities and serve patients across a broader range of disease stages. We are advancing opportunities that complement our core pneumatic compression therapies and expand the patient populations we can address.

Consistent with our previously stated commitment, a significant milestone came in October when we filed a 510(k) application for Flexitouch Pro, a meaningful enhancement to our advanced pneumatic compression system. Flexitouch Pro is designed to improve the patient and clinician experience through usability and connectivity enhancements that simplify therapy administration while delivering the clinical effectiveness that has made Flexitouch the long-standing market leader.

Subject to completion of the regulatory process, we are targeting a commercial launch of Flexitouch Pro in the second half of 2027. This innovation is intended to reinforce our leadership in advanced pneumatic compression and increase the value we deliver through our core franchise. We are also preparing to introduce MyoSleeve in the U.S. through our partnership with ElastiMed. Our next milestone is a focused VA pilot beginning in late Q4, which will help us evaluate the patient experience, clinical fit and appropriate go-to-market model before broader commercialization.

MyoSleeve is not reflected in our 2026 guidance, and we expect its contribution to build gradually over time. Strategically, it represents an opportunity to serve additional patients and expand the range of therapy needs our portfolio can address. Overall, we remain confident in the durability of our lymphedema business and the opportunities ahead in 2027 and beyond.

Each of our strategic priorities is at a different stage of development and their impact will build over time. Collectively, they are designed to strengthen the fundamental drivers of our lymphedema business, more patients being identified and referred, more eligible patients receiving therapy and a broader range of patients and care needs we can serve. That is the growth model we believe can support durable revenue growth and improving profitability over time.

With that, I'll turn the call over to Elaine to review our financial results and full year outlook.

Elaine Birkemeyer

Thanks, Sheri. Unless noted otherwise, all references to third quarter financial results are on a GAAP and year-over-year basis. Third quarter total revenue was $91.9 million, up $6.1 million or 7.1% as double-digit growth in lymphedema more than offset the expected decline in airway clearance.

By product line, revenue from our lymphedema products, including Flexitouch, Nimbl and LymphaTech increased $9.5 million or 13.1% to $81.8 million. Lymphedema growth was broad-based across payer channels with Medicare revenue increasing approximately 11% and commercial revenue increasing approximately 17% year-over-year, while VA revenue was approximately flat.

Revenue from our airway clearance product, AffloVest, decreased $3.4 million or 25.1% to $10 million, consistent with the DME inventory dynamics Sheri discussed earlier. Year-to-date, total revenue increased 12% to $252.8 million, led by 15% growth in lymphedema.

Moving down the P&L. Gross margin expanded to 76.7% of revenue from 75.8% in the third quarter of 2025. The increase primarily reflected lower manufacturing costs and favorable product mix and was consistent with the expectations embedded in our full year outlook. Third quarter operating expenses increased $6.9 million or 12.7% to $60.9 million. The increase primarily reflected the annualization of prior year sales force hiring and continued investment in technology and other capabilities supporting our growth.

These investments are directed at the growth drivers Sheri outlined, generating referrals, converting more referrals to shipment and expanding our portfolio. By expense category, the increase in operating expenses reflected a $3.2 million increase in sales and marketing expenses, a $0.3 million increase in research and development expenses, a $3.2 million increase in reimbursement, general and administrative expenses and a $0.1 million increase in intangible asset amortization and contingent consideration. Operating income was $9.6 million compared with $11 million in the prior year period.

Net interest income was $0.5 million, consistent with the prior year period. Income tax expense was $3 million compared to $3.2 million in the prior year period. Net income was $7.2 million or $0.31 per diluted share compared with $8.2 million or $0.36 per diluted share in the third quarter of 2025.

Adjusted EBITDA was $14.3 million compared to $14.4 million in the prior year period, and adjusted EBITDA margin was 15.6% compared to 16.8%. Gross margin improved 90 basis points, while higher operating expenses, including the annualization of prior year sales force hiring and continued investment in technology and operating capabilities more than offset that improvement.

Year-to-date, adjusted EBITDA has increased approximately 35% to $29.5 million, and we continue to expect adjusted EBITDA growth for the full year. Over time, as our investments mature and scale, we expect operating expenses to grow more slowly than revenue, supporting operating leverage and adjusted EBITDA growth.

On the balance sheet, we ended the quarter with $75.1 million in cash and no outstanding borrowings, up from $69.9 million at the end of the second quarter. During the third quarter, we generated $12 million in operating cash flow, which more than funded approximately $6.2 million in share repurchases.

As of September 30, 2026, approximately $12.5 million remained available under our $25 million share repurchase program. Our capital allocation priorities are unchanged. We will continue to invest in the commercial, operational and strategic capabilities that support organic growth, preserve capacity for disciplined M&A and repurchase shares when we believe valuation is attractive and doing so does not constrain our strategic priorities.

Now turning to our outlook. As Sheri mentioned, we are maintaining our full year 2026 revenue guidance of $360 million to $366 million, representing growth of approximately 9% to 11% year-over-year. Stronger lymphedema performance is offsetting a lower airway clearance outlook.

In lymphedema, we continue to expect low double-digit growth for the full year. For the fourth quarter, we expect meaningful sequential growth with a moderation in year-over-year growth compared to recent quarters as we lap a particularly strong fourth quarter of 2025 when lymphedema grew 16% on the initial benefit of NCD alignment.

In airway clearance, we now expect full year revenue to decline in the mid- to high single digits compared with our prior expectation of approximately flat. DME customers are taking longer than we initially expected to work through existing inventory as they transition to the next-generation AffloVest, so we now assume a more gradual normalization of ordering. This reflects ordering timing, not a change in patient demand or market leadership.

We expect sequential improvement in the fourth quarter with revenue remaining below the prior year, consistent with our full year outlook. Our total revenue range mainly reflects the timing of lymphedema referrals converting to shipments in the fourth quarter, our seasonally largest quarter. For modeling purposes, we expect the following for the full year: GAAP gross margin of approximately 76.5%, GAAP operating expense growth of 10% to 12%, net interest income of approximately $2.4 million, an effective tax rate of approximately 28% and fully diluted weighted average shares outstanding of approximately 23 million.

We are raising our full year 2026 EBITDA guidance to $50 million to $52 million, representing growth of approximately 12% to 16% compared with $44.8 million in 2025. Our adjusted EBITDA expectation includes the following adjustments: stock-based compensation expense of approximately $8.6 million, depreciation and amortization expense of approximately $7.3 million, executive transition costs of approximately $1.3 million, acquisition-related and integration costs of approximately $1.3 million and litigation-related costs of approximately $1 million.

With that, I'll turn the call back to Sheri for some closing remarks. Sheri?

Sheri Dodd

Thanks, Elaine. To close, this quarter reinforced the strength and durability of our core lymphedema business. We delivered another quarter of double-digit lymphedema growth, expanded gross margins and generated strong cash flow while investing in the capabilities that can support our next phase of growth. Our opportunity extends well beyond the patients we serve today.

By helping more patients get diagnosed and referred, converting more of those referrals to shipments and broadening the range of patients and therapy needs we can serve, we believe we can continue to expand the market we serve and increase the value we create along the patient journey.

At the same time, we remain focused on translating that growth into greater operating leverage over time. Our revenue guidance reflects our year-to-date performance and expectations for the remainder of the year, while our adjusted EBITDA guidance demonstrates continued financial discipline as we invest to support long-term growth. We believe Tactile is well positioned to deliver durable growth, expand operating leverage and long-term value for our shareholders.

Finally, I'd like to thank our Tactile Medical employees for their continued commitment to our patients, our clinical customers and one another.

With that, operator, we'll now open the call for questions.

Operator

[Operator Instructions] And our first question will come from Ryan Zimmerman with BTIG.

Preguntas y respuestas

Ryan Zimmerman

Elaine, congrats, the profitability. You have the company in such good fighting shape. Just wanted to mention that. If I could ask a little bit about 2027. I know it's early, and we're not going to get guidance. But first, as we think about any puts and takes, particularly with the airway clearance business normalizing, I wanted to get your thoughts around that. But then two, to ask in another way, is there any reason why the lymphedema market would change or slow down or your position and growth would be impacted in any capacity?

Because as I think about both the contributions from, say, Flexitouch Pro, you have the ElastiMed contributions coming in, in '27, you potentially have benefits from LymphaTech. It would seem that there should be some acceleration in the business, particularly on the lymphedema side. I know it's a lot.

Sheri Dodd

Ryan, well, we're smiling here, and thanks for the shout out on the profitability piece. Definitely a lot of work has been done on that side, and appreciate you acknowledging that. I'm going to start with the last point first on the lymphedema business. We don't see any reason why there should be a slowdown.

And in fact, the byproduct of more market awareness with the diagnostic coming into play with the continued, hopefully, favorable policies that support right patient, right pump at the right time. And certainly, from our standpoint, our operating model and our footprint in the field, we believe that this is not a disease area or category or even from our business that would see a slowdown. So we're feeling very good about lymphedema as a core growth driver for our business and the market to be super favorable in that area.

Your question about 2027. So we're not going to be putting any specific guides on 2027. But lymphedema business, we're feeling very confident in the durable growth, what you've seen over the past 5 consecutive quarters of double-digit growth, 13% in this quarter alone. And then for the AffloVest, as we've said, the inventory pacing is going to be a little bit different in Q4. We are going to see a sequential growth from Q3 to Q4.

It's going to be a bit more moderated than what we had talked about in Q2 as we've learned a little bit more about what's happening so far. But we believe that business will step back into what is going to be a good business, and we'll be able to participate with the products that we have, our next-generation AffloVest product, which remains the only untethered vest. It's still the lightest vest. It's a connected vest and continues to provide great value to patients. So without giving any guide on 2027, hopefully, that kind of gives you a flavor of how we're thinking about it.

Ryan Zimmerman

Very helpful. And Flexitouch Pro, any considerations that we need to be thinking about whether from a price or a margin standpoint as you introduce that to the market? I know you talked about some of the benefits maybe qualitatively, but just any quantitative considerations are helpful.

Sheri Dodd

Yes, you bet. So Flexitouch Pro will fall as an EO652. So that reimbursement will be what it currently is and whether we expect that to be for next year, which is usually increased at the same rate of [ COLA ]. So there won't be any upside or anything different from what is actually the reimbursement from the code standpoint. From an internal standpoint, gross margins will be in the ZIP code of our current products, of the current Flexitouch portfolio.

Operator

And our next question will come from Adam Maeder with Piper Sandler.

Kyle Edward Winborne

This is Kyle on for Adam. I might just push my luck here again with a 2027 question. I know you're not providing guidance at this time. But from a P&L standpoint, 2025 was an investment year. 2026, there were a lot of investments made as well, while you were also still able to show some good EBITDA growth in both years. So just curious, maybe just at a high level, qualitatively, how are you thinking about that for next year? Should we expect to kind of continue to see some leverage while also still investing in growth? Anything around that could be helpful.

Sheri Dodd

Yes. Thanks for the question. So we have committed to operating leverage and we're -- that is our commitment, and we'll continue to see that into next year. This year, of course, we had some annualization of the sales rep head, and we continue to invest in our business, both in terms of the transformational platform for our order operations, and those investments will continue into 2028. But we expect to see ongoing leverage, and that is our goal to both grow top line as well as bottom line.

From a revenue perspective, and as I shared with my comments with Ryan, there's nothing that says anything is going to be going down, that's going to be pulling or the market becomes less attractive. There is a reality that there is a large proportion of patients that are underserved, and there's no automatic button that allows suddenly a whole bolus of patients to get diagnosed even though we have the 3D Scanner in our portfolio.

There's a lot that needs to happen in order for these patients to get diagnosed. They still have to have the documentation. They still have to see their physicians. So we believe that there is a healthy market there, but I also want to temper some expectations that there isn't just a sudden hockey stick that happens because now we will have the Flexitouch Pro and the 3D Scanner. Takes time, it's chipping, but we are in the best position to be able to demonstrate some durable, sustainable growth in a way that is going to return value to shareholders. Does that answer your question?

Kyle Edward Winborne

Great. That's helpful. Yes, it did. That was great. And maybe just as a quick follow-up, congrats on the head and neck progress with payers. Just wanted to ask if you're willing to quantify how many wins you saw in removing some of that restrictive language? And then similarly, is there anything you could quantify in terms of when some of maybe the -- we could see some gradual revenue contribution from that population or just kind of how you expect that to unfold with those payer wins?

Sheri Dodd

Yes. So consistent to what we shared before, and I wish I had a different story here, but the nature of overturning and changing commercial policies has to be based on evidence and being kind of share of mind for the payers. And so we're not going to quantify or kind of call out the specific payers, but we did see some of those policies change that now have moved from E&I into covered. And so that gives us confidence that the evidence is resonating that payers are willing to change their policies. And then it's just kind of a block and tackle, block and tackle all the way down of getting that to change.

But that also takes some time and we'll build what we believe to be that pace into our 2027 revenue, but it won't be a hockey stick either. But the good news is more patients are going to get access to the only available therapy, compression pump therapy for the head and neck area post them surviving head and neck cancer. So it's an important technology advance and important population, and we're continuing to work really hard to make those policies change.

Operator

We'll go next to Brandon Vazquez with William Blair.

Brandon Vazquez

I wanted to ask first on AffloVest. Can you just talk a little bit about -- you made a comment that rebuilding inventory has been taking a little longer than you would have expected. Just talk a little bit about the visibility that you actually have on the sell-through of AffloVest and maybe why those -- the rebuilding of inventory is taking a little longer and the confidence you have that we're at the trough here on inventory.

Sheri Dodd

Yes. Thanks, Brandon. So Q2 AffloVest -- sorry, Q3 AffloVest delivered on expectations, and we gave our guidance at a time based on what we saw. And as we've gotten into Q4, we are seeing that pace of burning through the inventory being a little bit slower than we had forecasted when we last spoke to you. And so that is reflected in our current earnings as we've demonstrated here.

What's behind it is, again, there's no new DMEs that suddenly have said we have an inventory. It's the same DMEs that we identified in Q2. And depending on where that inventory is held, sometimes it's in the individual branches and sometimes it's central, but it can be different. And while we don't have real-time visibility into every location, we do know that because this is so concentrated with a few of our customers that when their timing is off, it actually can impact our quarter.

And so that's why we're being prudent and we're giving the guidance specifically on Afflo (sic) [ AffloVest ], and we're calling as we see it, which is a slight slowdown. What we do know is that there's no change in the underlying patient demand, the therapy effectiveness or competition. And so those things remain true. It's just this pace in our indirect business model, those aren't things that I can impact directly.

What we can do, again, is having great therapy, continue to train, continue to help the DMEs and support the work that they're doing, but this pace is something that really is not something I can directly control, and we're coming in as we see it right now.

Brandon Vazquez

Okay. And then on the lymphedema side, you guys have given a metric I don't think we get too often, which is that the referring clinics were up 10% year-to-date. I was curious if you could kind of talk a little bit about how does that number historically trend? Is this kind of a good predictor for you guys as you look forward into future growth? What type of accounts are new into the referral network? Are they different than what they've historically been? Just any more commentary around that. I thought it was a good interesting metric on the success you guys are seeing there on referrals. Just curious if we could get more color on how that might -- how it's developing and might impact the business.

Sheri Dodd

Yes. This isn't probably something we're going to update every time. But when we're reflecting on what we could share, we thought it would be good to put a little more quantification around what that rep productivity is actually really looking like. So -- and there's 2 aspects, right? So we have more feet on the street, and then we talked about the rep productivity being enhanced by the CRM tool. And then additionally, we have this overlay of market data that really helps the rep identify where are patients being diagnosed?

And are they in the clinics they're currently calling on or maybe they're in clinics that are outside of the current call point? And so that enhanced market insights really help our teams identify and prioritize the referral opportunities. So literally, more feet on the street and better tools. And while the insights are not real time, they're lagging 3 to 6 months, it's still good data. And so that is why we're seeing this really nice uptick on that year-over-year in clinic visits. And then looking at as well as I gave some metrics on -- just on our marketing programs, actually showing the 90-day pre and the 90-day post, what that actually does to help drive order growth.

So our investments in sales and marketing, when we look at metrics like this and then sharing a few of them with you hope to, you're seeing the value of the investments that we made in 2025 and where our dollars continue to go in, in 2026.

Operator

[Operator Instructions] And we'll go next to Ben Haynor with Lake Street Capital Markets.

Benjamin Haynor

First off for me, just on airway clearance and the DMEs that presumably some of them have worked through any inventory issues. Can you talk any about what you're seeing from those that do not have the inventory situation?

Sheri Dodd

Sure. So when we look at our -- a small handful of them have inventory issues and they're burning through that. On those that did not have excess inventory and they went and are currently selling Gen 6, what we're hearing is really strong feedback from both clinicians and patients on the product.

And so that appears to be going well, and we continue to help like we do even for those that have the excess inventory, help those DMEs help identify the patients that have bronchiectasis that haven't been put on treatment yet. And so that all is going as it's going. What I want to caution though is even though that adoption of the Gen 6 is good in the small handful of those that are still burning through their excess inventory, our forecasting for Q4 is reflecting both health in those that don't have inventory issues as well as the burn down in those that do.

But we just can't -- Ben, to be honest, we just can't overcome the excess -- the slowdown in the excess inventory burn with performance in the other DMEs. They're performing well, but they can't overcome, if you will, the slowdown with those that have the excess inventory.

Benjamin Haynor

Okay. That's helpful color. And then dipping my toe into 2027, anything you could tell us on expectations for what the kind of the field sales force looks like as we get into or exit next year?

Sheri Dodd

You know what, we're super excited to be basically activating our playbook. And when I say excited about that because it's one thing to say you have a playbook, it's another thing to actually use it. And so we are on, I think, part 6 of our go-to-market playbook which the basis of it is when territories get bigger, then we will split territories.

And then splitting that territory, we will put in place both a, what we call a territory account manager as well as that product specialist. So every time you split, you put 2 more in. And so as we look at territory performance, we'll be looking at splitting and some of those maybe that be underperforming, there could be some consolidation. So -- but nothing dramatic is going to happen here.

Just we'll run it like we said we were going to run it. The one difference, and I called this out in the script, is that we did stand up a strategic accounts function. Strategic accounts function, I think, is a natural evolution of any field commercial organization when there is national accounts, those accounts that are starting to be kind of high volume, how do you have a differentiated offering and more of a key account manager that helping to support both the programs and the relationships.

And so standing that up just this past quarter, we won't see any revenue tied to that in Q4, but we definitely would expect strong revenue performance in -- going into 2027, in line with the realities that I mentioned before. You want to have that connectivity to the strategic account, but it doesn't suddenly all of a sudden open up thousands and thousands and thousands of referrals that start coming through in a fast clip. But it's just a maturing of our organization and strategic accounts is a really good first step for us.

Benjamin Haynor

Okay. That makes sense. And lastly for me on the LymphaTech clearance, congrats on that. I believe you're monetizing that via a SaaS model at the moment. If you do get that Category I code down the line, do you intend to stick with the SaaS model? Or is this something where it could be a click fee? Or any thoughts that you care to share on how that ultimately gets monetized?

Sheri Dodd

We are still taking a look at that full business model. Pleased that right now, the 3D Scanner currently has a couple of large academic centers that are paying for it as a SaaS model. CPT III, the coding, it just starts as a tracking code and you have to build over time. So we're in early stages of building out that reimbursement pathway. And then we'll be taking and are currently taking and looking to reveal more of that next year what that actual business model looks like. So we're pleased to get the approval, obviously, of the expanded indication. That's the first step. The Category III code, that becomes the next step and then moving on to actually seeing full year commercialization, which will be seen later in '28 and '29.

Benjamin Haynor

It's a little bit down the line, but thanks for the thoughts there. And congrats on the quarter.

Operator

And this now concludes our question-and-answer session. I would like to turn the floor back over to Sheri Dodd for closing comments.

Sheri Dodd

Thanks, [ Chris ]. I just want to thank everyone for your thoughtful questions. Pleased that we were able to deliver again against our core business, that 13% growth in lymphedema and deliver on what we said we were going to do. We managed the AffloVest kind of shortfall with that strength of lymphedema and are really pleased to be able to keep our guide for the year and increase our pull-up on our EBITDA guide as we finish out the year. So thanks to you, and we look forward to having the one-on-one conversations. And for everyone else, we'll see you next quarter.

Operator

Ladies and gentlemen, thank you for your participation. This does conclude today's teleconference. You may disconnect your lines, and have a wonderful day.